Believe it or not, there are seven potential
levels of decision-making in a Social Security disability
claim. These range from the initial decision on your
application, through the administrative decision-making
process, and all the way through the federal court system,
including the United States Supreme Court. Needless
to say, the vast majority of claims do not make it through
all these levels. Most claims are concluded in the administrative
decision-making process. Relatively few cases make it
to the federal appellate courts, and the Supreme Court
decides a Social Security disability case only every
year or two.
The first step in obtaining benefits is the initial
application. The application process may be started
at your local Social Security office, and may be done
in-person or by telephone.
Your claim is first reviewed by disability examiners,
who make the initial decision of whether you are disabled
or not, according to Social Security standards. Only
about 30% of all claimants are awarded benefits at the
application level.
If you receive a denial on your application, you must
submit a form entitled Request for Reconsideration.
This must be completed and submitted or mailed to a
Social Security office within sixty (60) days from the
time you receive your first denial. Your file will be
reviewed by different examiners than those who initially
denied your claim. Less than 20% of denied claims are
allowed at the reconsideration level.
When you receive your second denial, you have sixty
(60) days to mail or submit a form entitled Request
for Hearing Before Administrative Law Judge. This is
the point in the process when many people choose to
retain an attorney. If you are going to get a lawyer
to represent you at the hearing, you should contact
him or her as soon as possible after receiving your
second denial.
Unfortunately, it usually takes a long time to get
a hearing date. It will likely take several months —
and often up to one year — to get to the hearing.
It is during this time that your attorney should be
collecting and evaluating relevant medical evidence.
If necessary, he or she may request special reports
from one of your physicians to present at the hearing.
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The hearing is the first (and usually the only) opportunity
you will have to present your testimony to a judge.
It is at the hearing that you “make the record”,
that is, establish the documentary and testimonial evidence
to support your claim for disability. Nationally, about
65% of claimants with denied claims prevail at the hearing
level.
If you receive an adverse decision from the administrative
law judge, you may appeal your claim to the Appeals
Council. The Appeals Council will not take new testimony.
In most cases, members of the Council simply review
the record from the hearing, including a transcript
of any testimony. The Council decides whether the judge’s
decision was legally correct, and whether it is adequately
supported by the facts in the record.
Although further appeals may be taken through the federal
court system, relatively few cases make it that far.
The majority of claims are concluded at some point during
the administrative decision-making process described
above.
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